Procedural complications of central venous catheter insertion

Central venous catheters (CVC) have complication rates as high as 20% and are associated with significant morbidity and mortality. In this study we wished to determine the incidence of procedural related complications at different venous access sites as well as the impact of ultrasound (US) use, operator experience and level of supervision of trainees in a prospective observational study.

Five hundred consecutive patients undergoing elective CVC insertion were prospectively followed. Data with regards to US use, operator experience, level of supervision, site of insertion and procedural complications were collected.

The overall rate of procedural complications was 19.5%. Operators with <25 insertions caused significantly more complications (25.2% vs. 13.6%). Arterial punctures occurred significantly more frequently when US was not used (7.2 vs. 2.1%) and at the subclavian site (8% vs. 1.6%). Higher levels of supervision were significantly associated with a decreased number of complications (10.7% vs. 23.8%). Subclavian vein as access point for the CVC resulted in significantly more overall complications (29.2% vs. 17.7%). Inexperienced operators combined with SCV approach were significant predictors for increased procedural-related complications.

Immediate procedural-related complications during CVC insertion are common. To reduce the incidence of procedural-related complications we advocate multiple strategies to assure central venous cannulation safety: 1) the internal jugular vein should be the primary target vessel; 2) trainees with <25 previous catheter insertions should be supervised at all times; 3) ultrasound may reduce the incidence of procedural-related complications.